Regularly drinking guava juice could be a simple and affordable way to help reduce the risk of anemia among women in low and middle income countries, according to a review of existing research published in the open access journal BMJ Nutrition Prevention & Health.

Researchers found that combining guava juice with iron supplements appears to be more effective at increasing hemoglobin levels than taking iron supplements alone. Based on the findings, they suggest that guava juice could be considered as part of dietary counseling programs aimed at preventing anemia in regions where the condition is common.

Anemia Remains a Major Health Challenge

Iron deficiency anemia is especially widespread among teenage girls and pregnant women in many low and middle-income countries. The condition can increase the risk of illness and death while also affecting energy levels, cognitive function, and overall well-being.

Guava may offer a practical nutritional solution in many parts of Asia, where the fruit is widely available and relatively inexpensive. It is an excellent source of vitamin C, a nutrient that helps the body absorb iron from plant-based foods.

According to the researchers, guava contains up to four times more vitamin C per 100 grams than oranges. The fruit also provides vitamin A, folate, dietary fiber, and small amounts of iron.

Although several small studies conducted in Indonesia have reported increases in hemoglobin levels after people drank guava juice, no comprehensive review had previously brought those findings together to evaluate the overall evidence.

Reviewing the Evidence

To address that gap, researchers searched scientific databases for clinical trials and quasi-experimental studies published in English since 2000.

Their review identified 17 eligible studies. Of these, 15 were quasi-experimental studies, and two were randomized controlled trials. Six studies focused on teenage girls, while 11 involved pregnant women. Nine studies specifically examined the effects of guava juice combined with iron supplementation.

The researchers pooled data from 12 quantitative studies involving 235 women and teenage girls. Overall, participants experienced an average increase in hemoglobin levels of 1.71 g/dl after consuming guava juice, indicating a significant improvement.

Hemoglobin Levels Improved in Both Groups

A closer analysis showed that teenage girls experienced an average increase of 1.52 g/dl, while pregnant women saw an average increase of 1.84 g/dl.

The review also examined five studies that directly compared two groups: one receiving guava juice together with iron supplements and another receiving iron supplements alone. Each group included 102 participants.

In those studies, hemoglobin levels were on average 1.29 g/dl higher in the group that consumed both guava juice and iron supplements.

“An increase of 1–2 g/dl may shift individuals from mild or moderate anemia to non-anemic categories, improving fatigue, cognitive function, and productivity outcomes,” suggest the researchers.

Limitations and Need for More Research

The researchers noted several limitations to the available evidence.

All of the studies included in the review were conducted in Indonesia. There were also substantial differences between studies in terms of design, intervention length, guava variety, dosage, and participant characteristics.

In addition, most of the studies used quasi-experimental methods rather than randomized controlled trial designs, making it harder to establish direct cause and effect relationships. The lack of long-term follow-up also means researchers cannot determine how long any improvements in hemoglobin levels might last.

Despite those limitations, the authors believe guava juice could have practical public health applications.

“Integrating guava juice into school nutrition programs, antenatal care packages, or community health initiatives could represent a feasible approach to address mild-to-moderate anemia, aligning with the United Nations’ Decade of Action on Nutrition (2016–2025), which emphasizes dietary diversification and locally sourced nutrient-rich foods,” they point out.

“Given its nutritional richness, affordability, and cultural acceptance across Asia, guava juice offers a promising low-cost intervention. Strengthening local supply chains, standardizing formulations and embedding such dietary approaches within public health nutrition programs could collectively contribute to more sustainable anemia control,” they add.

Experts Urge Caution

Professor Sumantra Ray, chief scientist & executive director, NNEdPro Global Institute for Food, Nutrition and Health, which co-owns BMJ Nutrition Prevention & Health, said the findings support what is already known about vitamin C and iron absorption.

“This study builds on the established role of dietary sources high in vitamin C to enhance iron absorption and improve the effectiveness of iron supplementation,” comments Professor Sumantra Ray, chief scientist & executive director, NNEdPro Global Institute for Food, Nutrition and Health, which co-owns BMJ Nutrition Prevention & Health.

However, he emphasized that the current evidence has important limitations.

“But quasi-experimental research, the wide variation in study design, small sample sizes, and limited length of follow-up mean that caution is required when interpreting the findings. Without further rigorous research, defining the best therapeutic dose and period of use, guava juice can’t be recommended as an alternative to conventional treatment in those at risk of iron deficiency anemia,” he adds.